Provider Demographics
NPI:1508265653
Name:BROWN, ILA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ILA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ILA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:899 FM 632
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-4516
Mailing Address - Country:US
Mailing Address - Phone:830-583-4003
Mailing Address - Fax:
Practice Address - Street 1:899 FM 632
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-4516
Practice Address - Country:US
Practice Address - Phone:830-583-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15566122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice